Support for proven, effective and affordable priority strategies in controlling the most devastating infectious diseases, including: Bednets and treatment strategies for rolling back malaria DOTS (Directly-Observed Treatment, Short-course) for stopping TB. Childhood vaccinations for reducing deaths from measles and other preventable diseases. IMCI (Integrated Management of Childhood Illnesses) for addressing diarrhoeal diseases. HIV prevention strategies such as condom prevention, sex education and STI treatment for reducing the spread of HIV/AIDS.

1. 1
Introduction to chemotherapy of
infectious diseases
Prepared by: Rajeev Sahai
B.Sc, M.Pharm (Pharmacology)

2. 13.3
million
Infectious diseases
25%
Cardiovascular
diseases 31%Cancers
13%
Injuries
11%
Maternal
5%
Respiratory and
digestive 9%
Other
6%
Leading causes of death
53.9 million from all causes, worldwide, 2008
Note: Cancers, cardiovascular and respiratory/digestive deaths can also be caused by infections
and raise the percentage of deaths due to infectious diseases even more
2

3. 3
0
0.5
1
1.5
2
2.5
3
3.5
Acute
respiratory
infections
(including
pneumonia
and
influenza)
AIDS* Diarrhoeal
diseases
TB Malaria Measles
Over age five
Under age five
Leading infectious killers
Millions of deaths, worldwide, all ages, 2008

4. Infectious
diseases
45%
Non communicable
conditions 35%
Injuries 11%
Perinatal 6%
Maternal
2%
Nutritional
1%
Main causes of death in low-income countries
In South-East Asia and Africa
Estimates for 2008
4

5. Infectious
diseases 63%
Perinatal 20%
Nutritional 3%
Non communicable
conditions 8%
Injuries 6%
Main causes of death among children
Ages 0 to 4 years
Estimates for 2008, worldwide
5

6. Infectious
diseases
48%
Injuries
19%
Non
communicable
conditions 18%
Perinatal 10%
Maternal 3% Nutritional 2%
Main causes of premature death
Ages 0 to 44 years
Estimates for 2008, worldwide
Source: WHO, 1999
6

7. Burkina
Faso
Kenya Malawi Nigeria Rwanda Sudan Sri lanka
4
3
2.7
2
3
6.2
4.3
Days of work lost from malaria
Estimated average time lost by adults due to one episode of
malaria
Source: Ettling. 1991 & 1994; Guiguemde, 1997; Leighton and Foster, 1993; Kondrasen, 1977
7

8. 0
20
40
60
80
100
Acute
respiratory
infections
Diarrhoeal
diseases
HIV / AIDS Malaria Measles TB Sexually
transmitted
infections
Pertussis Tropical
Diseases
DALYs
(millions)
73
71
39
30
Burden of disease
DALY’s (Disability Adjusted Life Years) lost in 2008 due to
infectious diseases, millions, all ages
83
73
71
39
28
17
13
11

9. Deaths
unavoidable
without new
tools
Preventable deaths (I)
It is estimated that the majority of deaths from infectious diseases
can be prevented with existing, cost-effective strategies
9

10. Preventable deaths (II)
 Childhood vaccinations have proven extremely effective in
reducing deaths from measles and other preventable diseases.
 Bednets and other prevention and treatment strategies can prevent
50% of all malaria deaths.
 DOTS (Directly Observed Treatment, Short-course) can prevent 60%
of all tuberculosis deaths.
10
Source: WHO

11. 11
Preventable deaths (III)
• IMCI (Integrated Management of Childhood Illnesses) can prevent
most childhood deaths from penumonia, diarrhoea, malaria and
measles. An important part of IMCI is oral rehydration therapy,
which can prevent up to 90% of deaths from diarrhoeal diseases.
•Antibiotics used in timely and correct doses, combined with other
strategies such as IMCI, are highly effective in preventing deaths
from pneumonia.
• HIV prevention strategies such as condom promotion, sex
education and treatment of STIs have been proven to reduce the
spread of HIV/AIDS.

12. 0
50
100
150
200
250
Routine childhood immunisation HIV/AIDS education in schools DOTS to control TB Integrated management of
childhood illness
Countries adapting WHO policies Countries not adapting WHO policies
Health policy void
Adopted
by
all
countries
171
Not
adopting
110
Not
adopting
63
Not
adopting*
120
developing
countries
only
212countriesandterritories
*Number of countries not adopting an intervention where it would be appropriate to do so.
Source: WHO
12

13. Smallpo
x
$1.07billio
n
estimated
savings in
direct
costs 1997
prices
Polio
$1.56 billion
projected s
savings
annually
Cholera
$770
Million lost
seafood
export,
Peru,
1991
Plague
$1.7 billion
lost tourist
income
and trade,
India, 1994
Malaria
$500
million
direct
costs,
Sub-
Saharan
Africa,
annually
MCD
$3 billion
direct
and
indirect
UK,
1997
Drug
Resistance
$4 billion
treatment
costs, US,
annually
AIDS
$14 billion
prevention
and health
care costs,
worldwide,
annually.
Economic burden
When infectious diseases are not controlled, they can place a tremendous
burden on economies.
Economic savings
The cost of controlling or eliminating
infectious diseases is often recovered
many times over in future savings.
Source: WHO
13

14. Antimicrobial resistance (I)
14
Malaria
Quinine and mefloquine in Thailand
45% resistance
Note: There is already complete resistance to chloroquine and
Sylfadoxine-pyrimethamine in Thailand

15. Antimicrobial resistance (II)
Tuberculosis
Short-course chemotherapy in
Portugal
4% multi drug
resistance
13% single
drug resistance
15

16. Antimicrobial resistance (III)
Staphylococcus
In Japan
60% multi drug resistance
16

17. Health Assistance
Infectious Diseases 1.5%Other areas of
health nutrition
population 7.3%
Total donor
assistance
worldwide
Limited funding (I)
Source: Global Comparative
Assessments in the Health Sector
17

18. Health
Expenditures
2.6% public sector
2.6% private sector
Limited funding (II)
Total GDP
worldwide
18

19. 0%
20%
40%
60%
80%
100%
Health research by both public and priate
sectors devoted to health problems in
developing countries
Global health R&D funding devoted to AIDS,
malaria, acute respiratory infections,
diarrhoeal diseases and TB
Health research budgets
10%
2%
19

20. Defending our borders
Strong national defence must include
protecting the population
from microbial invaders
$864 billion
Global military spending 1995
$15 billion
Estimated global spending for
prevention and control of AIDS,
TB and malaria, 1995
150 million
Estimated deaths from
AIDS,TB and malaria
since 1945
23 million
Military and
civilian
deaths from war
1945-1993
Source: US ACDA World Military Expenditures and Arms Transfers, 1996.
Ruth L. Sivard, World Military and Social Expenditures
20

21. Diarrhoeal diseases
64%
Respiratory
infection 8%
Fever
6%
Malaria 4%
Hepatitis 4%
Gonorrhoea 4%
Other
10%
Diseases affecting tourists
Exiting tourists with infectious diseases, Thailand 2007
21

22. 22

23. 23

24. Visiting friends
& Relations 49%
Immigrants
11%
Visitors to
UK 19%
Tourists 16%
Expatriates 5%
Malaria in the United Kingdom
A total of 8353 cases of imported
malaria in the United Kingdom between
1997-2002
Source: Behrens, Travel Morbidity in Ethnic Minority
Travelers
24

25. Affordable health services for developing countries
Disease Intervention Prevention or
treatment costs
Annual cost
per capita
(1990)
AIDS Treatment of STIs
Prevention programmes
$14 for a year’s supply
of condoms
$0.20
$1.70
TB DOTS strategy $20 for 6 months of
medicines
$0.60
Malaria Prevention $10 for a bednet
treated with insecticide
Being
determined
Measles Immunization $0.26 to administer one
dose of measles
vaccine
$0.50
Diarrhoeal
diseases
Integrated Management
of Childhood Illness
$0.33 for oral
rehydration salts
$1.60
ARI Treatment of pneumonia $027 for 5 days of
antibiotics
Being
determined
25Source for per capita spending: World Development Report, 1993. Source for prevention or treatment costs: WHO

26. 0
50
100
150
200
250
300
78 79 80 81 82 83 84 85 86 87 88 89 90 91 92
Success Stories (I)
ORT reduces diarrhoeal deaths among children in Mexico
ORT
introduced
Source: Guberrez et al, 1996
Mortalityrateper100000
26

27. 15
20
25
30
35
40
1992 1993 1994 1995 1996
Success Stories (II)
Sex education reduces HIV prevalence in Uganda
20-24 year olds in Nsambya
PercentHIVpositive
HIV education
Introduced in
1980s
Source: UNAIDS
27

28. 0
5
10
15
20
25
30
1990 1995
Nearly eradicated or eliminated (III)
Neonatal Tetanus
Annual reported cases, worldwide
Cases,thousands
Source: WHO
28

29. 0
1000
2000
3000
4000
5000
6000
1985
1987
1989
1991
1993
1995
1997
Nearly eradicated or eliminated (IV)
Leprosy
Reported prevalence, worldwideCases,thousands
Source: WHO
29

30. Impact of infectious disease control on
development
Vertical approaches to disease
control run the risk of compart-
mentalizing and distancing the
health sector from other
development activities.
Economic development
In addition to supporting the well-
being of the public and the labour
forces in other sectors, the health
sector also produces goods and
services that contribute to the
national economy.
Confusion among health
officials surrounding rhe
1994 outbreak of the plague
in Surat, India, undercut
indian tourism. More than
45,000 people cancelled
their travel plans to India.
Micro Credit loan defaiults
due to illness have been
reduced in Bangladesh
and other countries through
the strengthening TB cont
and other community
health programmes.
Community organizing by gays,
Lesbians and IV drug users in
response to AIDS has strength-
ened the capacity of these
communities to respond to other
social issues. Health initiatives are
frequently spearheads for develop-
ing community participation
National hospitals Many developing
country governments allocate more
than half of their health budgets
to hospitals, leaving little money
for basic health services.
Economic growth
Ten years of the malaria
Elimination programme in
Sri Lanka is estimated to have
Boosted national income by 13%
School attendance Children in the Solomon
Islands missed – on average – one week of
school each year due to malaria, prior to the
implementation of effective control strategies.
Worker Productivity
Weavers in India with
chronic symptoms of
lymphatic filaria produced
27% less cloth than
healthy weavers.
Negative impact
30
Positive impact

31. Safe drinking-water. The number of people
access to safe drinking-water has doubled
from 40% in 1980 to nearly 80% in some
countries, reducing the risk of diarrhoeal
diseases.
Mining settlements in the Amazon have
Contributed to an increase in malaria
Cases.
Impact of development on infectious disease
control Economic transition has affected health
Services and contributed to a resurgence of
TB and diphtheria in the Russian Federation
and Eastern Europe.
Adult literacy in developing countries has
increased from 34% in 1977 to 49% in
1985. This increases access to health
education messages.
Hydroelectric dams in China, Egypt,
Ghana and Senegal have led to an
Increase in schistosomiasis.
Positive impact
Negative impact
31

32. Priority steps for overcoming the burden of infectious
diseases (I)
• Political support – particularly money, policies and multi sector
involvement – is required to overcome the burden of infectious
diseases. By mobilizing political support to address the following
priorities, much of the death and suffering caused by infectious
disease could be prevented.
32

33. Priority steps for overcoming the burden of
infectious diseases (II)
• Support for proven, effective and affordable priority strategies in
controlling the most devastating infectious diseases, including:
 Bednets and treatment strategies for rolling back malaria
 DOTS (Directly-Observed Treatment, Short-course) for stopping TB.
 Childhood vaccinations for reducing deaths from measles and other
preventable diseases.
 IMCI (Integrated Management of Childhood Illnesses) for addressing
diarrhoeal diseases.
HIV prevention strategies such as condom prevention, sex education and
STI treatment for reducing the spread of HIV/AIDS.
33

34. Priority steps for overcoming the burden of
infectious diseases (III)
 Antibiotics used timely and appropriately for preventing pneumonia.
 Strengthened health services and delivery systems in developing
countries.
 Intensified efforts to eradicate polio and guinea worm, and eliminate
neonatal tetanus, leprosy, lymphatic filariasis, Chagas disease and
onchocerciasis.
 Expansion of surveillance systems that can alert the world to
unexpected outbreaks, the emergence of new diseases and increased
drug resistance.
 Investment in the development of diagnostic tools, drugs and vaccines
that can further improved our ability to affordably address the most
serious and widespread infectious diseases.
34

35. 35